By Rob Nahoopii
I recently had the opportunity to switch hospitals in a leadership role within my health-system. The hospital I moved to is a 340B DSH hospital. If you are not familiar with 340B, it is part of legislation that was created to help hospitals who have a disproportionate share of CMS (or medicare, medicaid patients). The help comes from lower drug costs extended to this group of hospitals from the drug companies. This lowered drug cost is supposed to help the hospitals stay afloat with the added load of CMS and uninsured patients as well as provide an opportunity for these hospitals to help even more patients. Below is one example that we have recently undertaken at my hospital. We have not completely figured it out, but we are making progress. We cannot use 340B on all of our patients because of some nuances in the program. The one thing I should note before I get into our example is that the implementation of this well intended legislation is very difficult. If you are eligible to use it, ask as many questions as you can and become active with the community of 340B eligible healthcare related entities.
My hospital's surrounding area has a young demographic and therefore a lot of babies. For instance, our average census in our newborn ICU is 42 (and we have seen our census peak at over 60 infants in the last few months). This translates to a lot of need for Synagis®. Although we typically administer the first dose in the hospital (which is not eligible for 340B pricing), many infants are discharged and need to receive further doses as an outpatient. Many pediatricians do not want to or will not purchase and administer Synagis due to the high cost of drug, marginal reimbursement, and a lengthy prior authorization process. I know, so why in the world would a hospital do it, NOT because we love to create difficult scenarios where the chance of successful reimbursement requires a lot of man power. We do it for the babies. These babies could be protected from a life threatening RSV infection, and so it goes without saying that it is the right thing to do.
What does 340B have to do with a Synagis clinic? A lot really. It is hard to sell administration on a new service if it will lose money. Sure, the insurance companies will cover the cost of the medicine (well, not always), but what about administration, physician time, prior authorization staff time, and everything else that goes into getting a medication from the pharmacy to the patient. Not to mention opportunity cost, could we have seen a patient that would have had better reimbursement for cost? So, this is where 340B comes in. With 340B pricing, we can create a win-win for everyone, which ultimately results in RSV protection for a vulnerable group of patients.
As a reminder, this is what 340B is supposed to do... Help Patients! Yes, it is to help offset costs for hospitals and clinics who take on a disproportionate share of CMS and indigent patients, but in the end we need to help patients.
My hospital's surrounding area has a young demographic and therefore a lot of babies. For instance, our average census in our newborn ICU is 42 (and we have seen our census peak at over 60 infants in the last few months). This translates to a lot of need for Synagis®. Although we typically administer the first dose in the hospital (which is not eligible for 340B pricing), many infants are discharged and need to receive further doses as an outpatient. Many pediatricians do not want to or will not purchase and administer Synagis due to the high cost of drug, marginal reimbursement, and a lengthy prior authorization process. I know, so why in the world would a hospital do it, NOT because we love to create difficult scenarios where the chance of successful reimbursement requires a lot of man power. We do it for the babies. These babies could be protected from a life threatening RSV infection, and so it goes without saying that it is the right thing to do.
What does 340B have to do with a Synagis clinic? A lot really. It is hard to sell administration on a new service if it will lose money. Sure, the insurance companies will cover the cost of the medicine (well, not always), but what about administration, physician time, prior authorization staff time, and everything else that goes into getting a medication from the pharmacy to the patient. Not to mention opportunity cost, could we have seen a patient that would have had better reimbursement for cost? So, this is where 340B comes in. With 340B pricing, we can create a win-win for everyone, which ultimately results in RSV protection for a vulnerable group of patients.
As a reminder, this is what 340B is supposed to do... Help Patients! Yes, it is to help offset costs for hospitals and clinics who take on a disproportionate share of CMS and indigent patients, but in the end we need to help patients.
About The Author: Rob Nahoopii is a hospital pharmacy manager at a large DSH community hospital with about 400 beds. He endeavors to share what he is going through with learning and implementing 340B at his hospital. He has teamed up with a colleague who is a pharmacist/attorney, who works in the same health-system at a corporate level. They hope to share their unique views on implementing 340B, and that you will join in on the conversation. Come visit their site to learn more at 340BProgram.org. Article Source: http://EzineArticles.com/?expert=Rob_Nahoopii |  |
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